Spondylolysis Treatment Options

Spondylolysis treatment is important to keep the wear-and-tear spine injury from developing into a more serious condition.

Spondylolysis starts with a stress fracture in a small area of bone at the back of the vertebra called the pars interarticularis. If the stress fracture/spondylolysis is allowed to worsen, it may result in a related condition known as spondylolisthesis. In spondylolisthesis, the bone shifts out of place and becomes unstable.

Spondylolysis mainly affects adolescent athletes who play sports requiring repeated hyperextension and rotation—i.e. arching and twisting—of the spine. Treatment starts with rest to allow the bone to heal, along with bracing and exercise therapy. Surgery is a last resort.

Bracing, Posture, and Exercise

Early diagnosis and treatment is key to getting back in action when you have spondylolysis. Treatment generally consists of a rest period that lasts between 2 weeks and 6 months, bracing to help minimize the posture (lumbar lordosis) associated with the instability and/or spinal stabilization exercises.

If back pain persists past 6 months, your child's doctor may suggest surgery.

We spoke with Dr. Lyle Micheli, orthopedic surgeon and Director of the Sports Medicine Division at Boston Children's Hospital, as well as Clinical Professor of Orthopedic Surgery at Harvard Medical School. Dr. Micheli works in varying capacities with US Rugby Football Foundation, the US Figure Skating, and the Boston Marathon.

At Children's Hospital in Boston, he says, most patients are adolescent and young adults who train seriously in at least one sport. There, patients are on the sidelines for about 4 to 6 weeks or until their pain, especially when they extend the spine, is gone. During that 4 to 6 weeks, for 23 hours per day, patients wear a brace that prevents extension of the spine. The brace helps to reduce lordosis of the lumbar spine and helps the bone in the area of the injury—i.e. the pars—to heal. Also during this time, patients go to physical therapy to help strengthen muscles that keep the spine from hyperextending and to develop flexibility of the pelvic floor muscles.

Unfortunately for the athlete, activity limits placed on them during the healing and treatment phase of this injury may seem to the young athlete even more painful than the injury itself. Still, activity during this time is limited to physical therapy exercises, stationary bicycling and certain swimming strokes. Anything that extends the spine is avoided.

After 4 to 6 weeks, the patient with spondylolysis is re-evaluated for spinal stabilization and degree of pain. If pain is still present, the wearing of the brace and the physical therapy exercise continues.

In 4 months, healing is again assessed, this time by means of an exam and a CT scan. At this point, the doctor is looking to see if and how well the bone at the pars has healed. If the test results show a bony union of the pars, and/or if the athlete is pain-free, the athlete is then allowed to fully return sports. She or he can also start gradually letting go of the brace.

While wearing the brace and doing physical therapy exercises is usually enough to heal spondylolysis and allow the athlete to return fully to sports, Micheli informs me. But in about 22% of the cases, other treatment modalities are needed. A relatively new procedure that may help heal the bone is electrical stimulation, he says.

Studies done by Micheli and others do show that external electrical stimulation may help decrease pain and heal fractures at the pars. But according to a 2016 review, the sample size (number of patients participating in the study) was too small to allow for a definitive conclusion to be drawn; because of this, the review authors decline to generalize the outcomes to rest of population with spondylolysis.

Lumbar Fusion

The final treatment option is surgery to stabilize the spine, generally a lumbar fusion. This is tried only after all conservative care procedures have proven ineffective. After surgery, patients are put in a cast or brace for at least 3 months, possibly up to 6 months, and are instructed to play no sports for a year post surgery.

And if you play contact sports, you have no guarantees of returning to the field at all after this surgery.